R.Ya. Shpaner, A.Zh. Bayalieva
Interregional clinical diagnostic centre, Kazan, Russia
Kazan State medical academy, Kazan, Russia
The study goal has been to compare an effect of propofol and sevoflurane on intracranial pressure (ICP) in removal of mass lesions of the brain.
Material and Methods. We compared 2 groups. Sevoflurane (2 MAC) + phentanyl (75±12 mg/kg) anesthesia was used in the first group (n=30). Propofol (3.0-3.5 mg/kg/h) + phentanyl (75±12 mg/kg) anesthesia was given in the second group (n=28). Mean age and operation duration were 53±12.3 years and 214.3±63.8 min, respectively. The first group consisted of cases with supratentorial tumors (27; 90%) and neoplasms of the posterior cranial fossa (3; 10%). As for the second group, a number of cases with the same types of tumors was 24 (85%) and 4 (15%), respectively. ICP measurement was carried out under identical conditions in both groups.
Results. The initial level of ICP, watched in normal ventilation (PaCO2=33-35 mm Hg) in the first group, was 24.6±5.1. Sevoflurane anesthesia led to ICP increase by 12-15% (27.8±5.4); it was eliminated by hyperventilation (PaCO2=26-28 mm Hg), carried out until ICP indices reached the value of 21.8±1.9 (reduction by 10-12% from the initial level). As far as the second group was concerned, the initial level of ICP was 24.2±4.3 (unreliable difference between the groups). Bolus administration of propofol during induction anesthesia resulted in ICP decrease up to 21.4±3.1 (by 10-12% on the average). However, this effect was short-term (not more than 5-7 min) and there was no significant ICP reduction during basic anesthesia (23.9±2.9).
Conclusion. The obtained results demonstrate, that in case of high initial levels of ICP unfavorable effects of intracranial hypertension, watched during inhalation anesthesia, can be reduced by hyperventilation. Propofol makes it possible to decrease ICP for a short period of time, which is enough for performing osteoplastic trephination.